Interatrial septal tachycardias following atrial fibrillation ablation or cardiac surgery: Electrophysiological features and ablation outcomes

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Interatrial septal tachycardia (IAS-AT) represented 9% of organized atrial tachycardia (AT) following atrial fibrillation (AF) ablation or cardiac surgery referred for radiofrequency catheter ablation (RFCA). The majority (93%) were targeted from the superior interatrial septum (IAS) limbus and the remaining 7% from the inferior limbus (left). Multiple interatrial septal connections at the level of the superior (red dotted lines) and inferior limbus (red circle) (right) may provide the anatomic substrate for IAS-AT. BB = Bachmann bundle; ICV = inferior vena cava; LA = left atrium; LAA = left atrial appendage; LS = left superior pulmonary vein; RA = right atrium; RAA = right atrial appendage; RI = right inferior pulmonary vein; RS = right superior pulmonary vein; SCV = superior vena cava; SP = septopulmonary bundle. (Anatomic image reproduced with permission from Ho and Sanchez-Quintana.¹⁵)

     

短期留置导尿管拔除在泌尿外科肾部分切除术后患者中的应用研究

【目的】 将短期留置导尿管拔除的最佳证据应用于临床,提高护士在肾部分切除术后尿管拔除实践活动中证据应用的依从性,降低留置尿管感染风险发生率,提高患者舒适度。【方法】 遵循JBI循证护理中心的临床证据实践应用系统(JBI-PACES)的标准程序,采用现场观察、查阅护理病历及资料收集等方法,以护士行为依从性水平、留置导尿管感染风险发生率、患者舒适度改变程度评价证据应用前后的有效性。【结果】 基线审查标准中护士对“肾部分切术后患者在午夜拔尿管”“护士主导评估尿管拔除时机”“拔除导尿管前给予单剂量a受体阻滞剂”等3条标准中在证据应用后依从性显著提高(p≤0.005);平均留置尿管时间由证据应用前的平均(135.75±11.70)h缩短至(90.45±9.62)h(p＜0.005);患者舒适度明显提高。【结论】 本课题研究应用于临床,提高了护士在主导短期尿管拔除实践中的依从性,帮助形成导尿管拔除和管理规范,降低留置尿管感染风险发生率,并提高患者舒适度。     

鼻胆管引流术后的导管相关性感染分析

目的了解在经内镜下逆行胰胆管造影术(ERCP)后行鼻胆管引流术(ENBD)的导管感染情况,研究鼻胆管导管感染危险因素及预防策略。方法回顾性分析2011年8月至2014年8月我院收治的218例行ERCP术后放置鼻胆管患者的导管感染率、相应的感染源及感染途径、感染细菌培养结果。结果 ERCP手术放置鼻胆管导管感染率为7.3%,感染源有胃肠道、导管堵塞及胆管自身因素;感染细菌培养结果主要为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、肠球菌及金黄色葡萄球菌、鲍曼不动杆菌。结论逆行胰胆管造影术后鼻胆管引流术后发生鼻胆管导管感染的概率低(7.3%),感染途径主要为胆肠逆行感染及经血、细菌感染以革兰阴性菌为主。     

Carto系统标测和指导射频消融快速心律失常

目的　评价Carto系统电解剖标测和指导射频消融治疗快速心律失常应用价值。方法　选择各种快速心律失常患者共 5 6例 ,其中室上性心动过速 (室上速 ) 4 9例 [房室结双径路 8例 ,房性心动过速 (房速 ) 12例 ,心房扑动 (房扑 ) 10例 ,左、右房室旁道 19例 ],室性心动过速 (室速 ) 7例 ,在心动过速或窦性心律时应用Carto系统标测 ,从其电解剖传导图中判断心律失常起源和发生机制 ,并指导射频消融。结果　 5 3例消融成功 ,消融成功率 94 6 %。 1例右侧游离壁旁道、1例右房房速和 1例不典型房扑消融不成功。房室结双径路 8例。左、右房室旁道 19例。 12例房速中左房房速 4例 ,右房房速 8例。 7例典型房扑 ,3例不典型房扑。特发性右室流出道室速 3例 ,特发性左室室速 3例 ,心肌梗死后室速 1例。手术时间为 (12 8± 5 9)min ,曝光时间为 (14± 12 )min。 1例穿剌左锁骨下静脉时发生气胸并发症。随访 1～ 14个月 ,1例左房房速复发 ,经Carto系统再次标测和消融成功。结论　Carto系统可安全有效应用于各种快速心律失常的标测和消融 ,减少X线曝光时间。它将心内电图与三维解剖结构联系起来 ,判断不同心律失常机制及起源部位 ,对指导消融有较大价值。利用其定位记忆功能 ,可避免损伤传导系统及进行补充放电 ,减少并     

Catheter ablation and antiarrhythmic drugs for haemodynamically tolerated post-infarction ventricular tachycardia; long-term outcome in relation to acute electrophysiological findings.

AIMS: Radiofrequency catheter ablation is effective at terminating ventricular tachycardia, but the overall clinical role of the technique in patients with a prior myocardial infarction is still debated, due to the uncertainties of the long-term reliability of the procedure. The purpose of this study was to prospectively investigate the relationship between acute results obtained by catheter ablation and long-term outcome in a homogeneous population of patients with post-myocardial infarction ventricular tachycardia. METHODS AND RESULTS: One hundred and twenty-four consecutive patients with recurrent, drug-refractory, haemodynamically tolerated ventricular tachycardia were included in the study. This population accounted for 30% of the patients with post-myocardial infarction ventricular tachycardia admitted between April 1992 and September 1997 to the investigating centres. The ablation was successful in eliminating sustained ventricular tachycardia in 91 of them (73%); a partial result was obtained in 21 (17%) and failure in 12 (10%). Low dose amiodarone and/or beta-blockers were maintained in 86% of the patients. Over a median follow-up of 41.5 months (interquartile range 30.5-59.5 months), there were 15 deaths (12%), three of which were sudden (2.4%); the 12 remaining patients died of heart failure. Event-free survival analysis showed a significantly lower ventricular tachycardia recurrence rate in patients with a successful procedure as compared to those with failure or a partial result (19% vs 53% at one year and 27% vs 60% at 3 years, P=0.003). A repeat procedure was performed in 15 patients with early recurrences and was followed in all by long-term success. Of those who submitted to a second procedure, 93/124 patients (75%) are free of ventricular tachycardia recurrences. An implantable cardioverter-defibrillator (ICD), following procedure failure, was implanted in 13 patients (11%) of the study population. CONCLUSIONS: Radiofrequency catheter ablation is effective in a wide population of patients with recurrent tolerated ventricular tachycardia, with very low sudden death and cardiac mortality rates over the long-term. Persistent ventricular tachycardia inducibility after catheter ablation requires an ICD implant and/or repeat ablation.     

经心内和食管快速心房刺激对P波时限及离散度的影响

目的分析快速心房刺激对P波时限及离散度的影响。方法在74例射频消融术经电极导管起搏高位右房及82例经食管心房调搏检查者中,用180次/分的S1S1刺激心房3min,在刺激前后立刻记录12导同步心电图,通过心电图测出刺激前后的最大P波时限(Pmax)、最小P波时限(Pmin)及P波离散度(Pd),然后进行比较。结果:射频消融组Pmax在心房刺激后比刺激前有显著性延长(P<0.01),Pmin及Pd无显著性差异。食管心房调搏组Pmax及Pd在心房刺激后显著性增加(P<0.01),Pmin无显著性差异。结论:快速心房刺激能引起心房传导时间延长,非均质电活动的离散程度增加。     

Localization and radiofrequency ablation of slow conducting pathway in left free wall

Objectives To study the Electrophysiologic characteristics and method of radiofrequency ablation in patients with slow conduction in left free wall. Methods When 5 cases induced tachycardia, using VS2 program stimulation terminated the tachycardia to establish that ventricle is the part of reentry circle. Results No retrograde A waves in 4 cases but only 1 case present A wave in terminating tachycardia. The accessory pathways have decreasing conduction in One case. Successful ablation were located in ventricle sides. Conclusions Ventricular sense and S2 program stimulation to terminate tachycardia is a reliable method to different atrial tachycardia . A wave of successful targets ahead of A wave of any coronary sinus leads is 8 -22 ms.